Managing pain
Cancer pain
Rheumatology
Sharon is about to have a knee replacement
| PMHx | Osteoarthritis Hypertension |
| Current medications | Tramadol SR 200mg BD Piroxicam 20mg daily Paracetamol 1g TDS Candesartan/hydrochlorothiazide 16mg/12.5mg daily |
What are some of the things we need to think about before and after surgery?
Beverly is 40 years old (and is 65kg). She has been finding it harder to get the kids ready for school in the morning due to pain in her hands
Her key symptoms
Pain, swelling and reduced movement in joints of both hands
Morning stiffness that lasts for about 2 hours
Fatigue
Current medications include: thryoxine 150\(\mu\)g, paracetamol 1g PRN and glucosamine
Initial treatment Which of the following is MOST LIKELY as INITIAL treatment for Beverly’s symptoms
A. Regular paracetamol
B. Diclofenac 50mg TDS
C. Fish oil
D. Methotrexate 10mg WEEKLY
E. Etanercept therapy
Beverly’s mother suffers from rheumatoid arthritis, she was diagnosed at 52 years of age
GP sends Beverly for blood tests, and X-rays
| Test | Results |
|---|---|
| Rheumatoid Factor | Positive |
| C-reactive protein | Elevated |
| X-rays | Limited evidence of joint erosion |
Beverly is diagnosed with rheumatoid arthritis.
Which of the following is the MOST appropriate first-line therapy for long-term disease control?
A. Diclofenac or Celecoxib
B. Hydroxychloroquine
C. Methotrexate 10mg WEEKLY
D. Etanercept therapy
E. Methotrexate or Etanercept
Which of the following will be considered FIRST if methotrexate is only partly effective for Beverly?
A. Stop methotrexate
B. Add another DMARD (hydroxychloroquine, sulphasalazine)
C. Start cytokine modulator (bDMARD)
D. Increase NSAID
E. Add corticosteroids
William is 53 years old and has chronic non-specific low back pain. His back pain started 2 years ago when he was doing some home renovations.
He describes his back pain as relatively constant, it occasionally radiates down both buttocks and hamstrings. At times he experiences a shooting pain up his spine or towards his buttocks.
His pain effects his sleep, relationships and work.
His current medications are
Â
Identifying patients at higher-risk of opioid-related harm who might benefit from take-home naloxone (Bui et al., 2022):
Can NSAIDs be differentiated according to…